潮气量挑战预测手术室液体反应性：一项观察性研究。

Tidal volume challenge to predict fluid responsiveness in the operating room: An observational study.

机构信息

From the Department of Anaesthesia and Intensive Care Medicine, IRCCS Humanitas, Humanitas University, Milan (AM, MC), the Department of Anaesthesia and Intensive Care Medicine, Maggiore della Carità University Hospital, Novara (CM, GC, FG, LM, FDC), the Department of Anaesthesiology and Intensive Care, San Bortolo Hospital, Vicenza (SDR), and the Department of Anaesthesia and Intensive Care, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy (PN).

出版信息

Eur J Anaesthesiol. 2019 Aug;36(8):583-591. doi: 10.1097/EJA.0000000000000998.

DOI:10.1097/EJA.0000000000000998

PMID:31021879

Abstract

BACKGROUND

Pulse pressure variation (PPV) and stroke volume variation (SVV) do not predict fluid responsiveness when using a protective ventilation strategy: the use of functional haemodynamic tests can be useful to overcome this limitation.

OBJECTIVES

We tested the use of a tidal volume challenge (VTC), during 6 ml kg [predicted body weight (PBW)] ventilation, and the end-expiratory occlusion test (EEOT) for prediction of fluid responsiveness.

DESIGN

An interventional prospective study.

SETTING

Supine elective neurosurgical patients.

INTERVENTIONS

The study protocol was, first, the initial EEOT test was performed during baseline 6 ml kg PBW ventilation; second, VTC was performed by increasing the VT up to 8 ml kg PBW and PPV and SVV changes were recorded after 1 min; third, a second EEOT was performed during 8 ml kg PBW ventilation; and VT was reduced back to 6 ml kg PBW and a third EEOT was performed. Finally, a 250 ml fluid challenge was administered over 10 min to identify fluid responders (increase in stroke volume index ≥10%).

RESULTS

In the 40 patients analysed, PPV and SVV values at baseline and EEOT performed at 6 ml kg PBW did not predict fluid responsiveness. A 13.3% increase in PPV after VTC predicted fluid responsiveness with a sensitivity of 94.7% and a specificity of 76.1%, while a 12.1% increase in SVV after VTC predicted fluid responsiveness with a sensitivity of 78.9% and a specificity of 95.2%. After EEOT performed at 8 ml kg PBW, a 3.6% increase in cardiac index predicted fluid responsiveness with a sensitivity of 89.4% and a specificity of 85.7%, while a 4.7% increase in stroke volume index (SVI) with a sensitivity of 89.4% and a specificity of 85.7%.

CONCLUSION

The changes in PPV and SVV obtained after VTC are reliable and comparable to the changes in CI and SVI obtained after EEOT performed at 8 ml kg PBW in predicting fluid responsiveness in neurosurgical patients.

TRIAL REGISTRATION

ACTRN12618000351213.

摘要

背景

在使用保护性通气策略时，脉压变异（PPV）和每搏变异（SVV）不能预测液体反应性：使用功能性血流动力学测试可能有助于克服这一限制。

目的

我们测试了在 6ml/kg[预测体重（PBW）]通气时使用潮气量挑战（VTC）和呼气末阻断试验（EEOT）来预测液体反应性。

设计

一项干预性前瞻性研究。

设置

仰卧位择期神经外科患者。

干预措施

研究方案如下：首先，在基线 6ml/kg PBW 通气时进行初始 EEOT 试验；其次，通过将 VT 增加到 8ml/kg PBW 来进行 VTC，并在 1 分钟后记录 PPV 和 SVV 的变化；再次，在 8ml/kg PBW 通气时进行第二次 EEOT；然后将 VT 降低回至 6ml/kg PBW，并进行第三次 EEOT。最后，在 10 分钟内给予 250ml 液体冲击，以确定液体反应者（每搏量指数增加≥10%）。

结果

在 40 名分析的患者中，基线时的 PPV 和 SVV 值以及在 6ml/kg PBW 时进行的 EEOT 均不能预测液体反应性。VTC 后 PPV 增加 13.3%可预测液体反应性，其敏感性为 94.7%，特异性为 76.1%，而 VTC 后 SVV 增加 12.1%可预测液体反应性，敏感性为 78.9%，特异性为 95.2%。在 8ml/kg PBW 时进行 EEOT 后，心指数增加 3.6%可预测液体反应性，其敏感性为 89.4%，特异性为 85.7%，而每搏量指数（SVI）增加 4.7%，敏感性为 89.4%，特异性为 85.7%。